Citation Information :
Zhou Y, Coleman S, Boysen J, Pansegrau ML, Wright MM, Carpel EF, Armbrust KR. Survival in Patients with Neovascular Glaucoma Following Tube Shunt Implant or Cyclodestructive Procedure. J Curr Glaucoma Pract 2022; 16 (2):74-78.
Purpose: The study purpose was to assess patient survival after tube shunt implant or cyclodestructive procedure for neovascular glaucoma and to determine whether specific preoperative factors are predictive of survival.
Materials and methods: A retrospective chart review was performed on patients with neovascular glaucoma who underwent tube shunt implant and/or cyclodestructive procedure between January 2002 and December 2019 at the Minneapolis Veterans Affairs Health Care System. Patient survival was compared to the age and gender-matched Minnesota population. Cox regression analyses were performed to evaluate preoperative parameters and survival.
Results: Tube shunt alone was implanted in 30 eyes, cyclodestruction alone was performed in nine eyes, and two eyes underwent both (n = 41 eyes, 39 patients). The postoperative 5-year survival rate was 62% in neovascular glaucoma patients compared to 80% in controls. Survival did not differ significantly based on neovascular glaucoma etiology. Preoperative best-corrected visual acuity of the neovascular glaucoma-affected eye (p = 0.05) and Charlson Comorbidity Index (p = 0.02) were associated with survival, but preoperative maximum intraocular pressure, hemoglobin A1c, and creatinine were not. The mean intraocular pressure at 6 months postprocedure was 14 mm Hg for tube shunt and 27 mm Hg for cyclodestruction (p = 0.03).
Conclusion: Neovascular glaucoma patients have reduced survival, but the majority survived at least 5-year postprocedure. Ophthalmologists should consider patient survival and factors predictive of survival when planning procedures for neovascular glaucoma.
Clinical significance: Our findings provide an updated perspective on survival in the setting of neovascular glaucoma and can help ophthalmologists provide patient-centered and holistic care.
Rong AJ, Swaminathan SS, Vanner EA, et al. Predictors of neovascular glaucoma in central retinal vein occlusion. Am J Ophthalmol 2019;204:62–69. DOI: 10.1016/j.ajo.2019.02.038.
Su CW, Chang YC, Lin CL, et al. Association of neovascular glaucoma with risk of stroke: a population-based cohort study. J Ophthalmol 2017;2017:1851568. DOI: 10.1155/2017/1851568
Blanc JP, Molteno AC, Fuller JR, et al. Life expectancy of patients with neovascular glaucoma drained by molteno implants. Clin Exp Ophthalmol 2004;32(4):360–363. DOI: 10.1111/j.1442-9071.2004.00837.x
Molteno AC. Low tension neovascular glaucoma treated by draining implant. Trans N ZOphthalmol Soc 1983;35:81–84.
US Department of Veterans Affairs. 172VA10P2: VHA Corporate Data Warehouse – VA. 79 FR 4377. Updated and Accessed 5 August 2020.
VA Informatics and Computing Infrastructure (VINCI), VA HSR RES 13–457, U.S. Department of Veterans Affairs. (2008). Retrieved 5 August 2020, from https://vaww.VINCI.med.va.gov.
Wei R, Anderson RN, Curtin LR, et al. U.S. decennial life tables for 1999–2001: state life tables. Natl Vital Stat Rep 2012;60(9):1–66.
Siantar RG, Cheng CY, Cheung CM, et al. Impact of visual impairment and eye diseases on mortality: the Singapore Malay eye study (SIMES). Sci Rep 2015;5:16304. DOI: 10.1038/srep16304.
Cugati S, Wang JJ, Knudtson MD, et al. Retinal vein occlusion and vascular mortality: pooled data analysis of 2 population-based cohorts. Ophthalmology 2007;114(3):520–524. DOI: 10.1016/j.ophtha.2006.06.061.
Sanchez-Tabernero S, Juberias JR, Artells N, et al. Management and systemic implications of diabetic Neovascular Glaucoma. Ophthalmic Res 2019;62(2):111–115. DOI: 10.1159/000500607.
Zhang T, Jiang W, Song X, et al. The association between visual impairment and the risk of mortality: a meta-analysis of prospective studies. J Epidemiol Community Health 2016;70(8):836–842. DOI: 10.1136/jech–2016–207331.
Agha Z, Lofgren RP, VanRuiswyk JV, et al. Are patients at veterans affairs medical centers sicker? A comparative analysis of health status and medical resource use. Arch Intern Med 2000;160(21):3252–3257. DOI: 10.1001/archinte.160.21.3252
Olivieri DJ, Lynch MG, Cockerham GC, et al. A survey of glaucoma surgery practice patterns in the veterans health administration. Mil Med 2020;185(7-8):e972–e976. DOI: 10.1093/milmed/usaa033
Choy BNK, Lai JSM, Yeung JCC, et al. Randomized comparative trial of diode laser transscleral cyclophotocoagulation versus Ahmed glaucoma valve for neovascular glaucoma in Chinese - a pilot study. Clin Ophthalmol 2018;12:2545–2552. DOI: 10.2147/OPTH.S188999.
Bloom PA, Clement CI, King A, et al. A comparison between tube surgery, ND:YAG laser and diode laser cyclophotocoagulation in the management of refractory glaucoma. Biomed Res Int 2013;2013:371951. DOI: 10.1155/2013/371951.